For which clinical rules do doctors want decision support, and why? A survey of Dutch general practitioners.

Despite the promise of decision support for improving care, alerts are often overridden or ignored. We evaluated Dutch general practitioners' intention to accept decision support in a proposed implementation based on clinical rules regarding care for elderly patients, and their reasons for wanting or not wanting support. We developed a survey based on literature and structured interviews and distributed it to all doctors who would receive support in the proposed implementation (n = 43), of which 65 percent responded.

Is frequent attendance of longer duration related to less transient episodes of care? A retrospective analysis of transient and chronic episodes of care.

Objectives: Frequent attenders (FAs) suffer more and consult general practitioners (GPs) more often for chronic physical and psychiatric illnesses, social difficulties and distress than non-FAs. However, it is unclear to what extent FAs present transient episodes of care (TECs) compared with non-FAs.

Design: Retrospective analysis of all episodes of care (ECs) in 15 116 consultations in 1 year.

Atrial fibrillation is an independent risk factor for ventricular fibrillation: a large-scale population-based case-control study.

Background: Atrial fibrillation (AF) is associated with sudden cardiac death. We aimed to study whether AF is associated with ventricular fibrillation (VF), the most common cause of sudden cardiac death and whether this association is independent of confounders, ie, concomitant disease, use of antiarrhythmic or QT-prolonging drugs, and acute myocardial infarction.

Methods And Results: We performed a community-based case-control study.

Why do they keep coming back? Psychosocial etiology of persistence of frequent attendance in primary care: a prospective cohort study.

Background: Patients who visit their General Practitioner (GP) very frequently over extended periods of time often have multimorbidity and are costly in primary and specialist healthcare. We investigated the impact of patient-level psychosocial and GP-level factors on the persistence of frequent attendance (FA) in primary care.

Methods: Two-year prospective cohort study in 623 incident adult frequent attenders (>90th attendance centile; age and sex-adjusted) in 2009.

Incidence of calcaneal apophysitis in the general population.

Background: Calcaneal apophysitis, or Sever's disease, is a traction apophysitis. It is a frequent cause of heel pain in children. Knowledge about the exact incidence of calcaneal apophysitis in the general population, however, is lacking.

Morbidity and doctor characteristics only partly explain the substantial healthcare expenditures of frequent attenders: a record linkage study between patient data and reimbursements data.

Background: Frequently attending patients to primary care (FA) are likely to cost more in primary care than their non-frequently attending counterparts. But how much is spent on specialist care of FAs? We describe the healthcare expenditures of frequently attending patients during 1, 2 or 3 years and test the hypothesis that additional costs can be explained by FAs' combined morbidity and primary care physicians' characteristics.

Methods: Record linkage study.

Predictability of persistent frequent attendance in primary care: a temporal and geographical validation study.

Background: Frequent attenders are patients who visit their general practitioner exceptionally frequently. Frequent attendance is usually transitory, but some frequent attenders become persistent. Clinically, prediction of persistent frequent attendance is useful to target treatment at underlying diseases or problems.

Attitudes and experience of Dutch general practitioners regarding computerized clinical decision support.

Unlabelled: Dutch general practices have a high adoption rate for computerized patient records and clinical decision support. We sought to measure the attitudes and experience of Dutch general practitioners towards clinical decision support.

Methods: A preliminary survey was created based on questions from published surveys, modified with the results of interviews.

Prevalence and medical risks of body packing in the Amsterdam area.

Aim: Body packing is a way to deliver packets of drugs across international borders by ingestion. The aim of the study was to provide an estimate of the medical risks of body packing, describe predictors for hospital referral in detained body packers and provide an estimate for the prevalence of body packing in the Amsterdam area.

Methods: From May 2007 to December 2008, we studied medical records of body packers immediately detained after arrival at Amsterdam Schiphol airport, hospital records of both detained body packers and self-referrers at two emergency departments of hospitals in Amsterdam and records kept by forensic physicians in charge of post-mortem examinations of all unnatural deaths in the area (years 2005-2009).

Epilepsy is a risk factor for sudden cardiac arrest in the general population.

Background: People with epilepsy are at increased risk for sudden death. The most prevalent cause of sudden death in the general population is sudden cardiac arrest (SCA) due to ventricular fibrillation (VF). SCA may contribute to the increased incidence of sudden death in people with epilepsy.

Diabetes care: reasons for missing HbA1c measurements in general practice.

Background: Glycated haemoglobin (HbA1c) is often used as one of the indicators to measure the quality of diabetes care. Complete registration is difficult to obtain. This study investigated the reasons for missing HbA1c measurements.

Usefulness of primary care electronic networks to assess the incidence of chlamydia, diagnosed by general practitioners.

Background: Chlamydia is the most common curable sexually transmitted infection (STI) in the Netherlands. The majority of chlamydia diagnoses are made by general practitioners (GPs). Baseline data from primary care will facilitate the future evaluation of the ongoing large population-based screening in the Netherlands.

Idiopathic superficial thrombophlebitis and the incidence of cancer in primary care patients.

Purpose: The association of spontaneous venous thromboembolism with occult malignancy is well established. Less clear is the incidence of subsequent cancer in patients with superficial thrombophlebitis. We wanted to determine the incidence of cancer after an episode of spontaneous superficial thrombophlebitis in a large general practice population.

Predictability of persistent frequent attendance: a historic 3-year cohort study.

Background: Few patients who attend GP consultations frequently continue to do so long term. While transient frequent attendance may be readily explicable, persistent frequent attendance often is not. It increases GPs' workload while reducing work satisfaction.

Epidemiology of frequent attenders: a 3-year historic cohort study comparing attendance, morbidity and prescriptions of one-year and persistent frequent attenders.

Background: General Practitioners spend a disproportionate amount of time on frequent attenders. So far, trials on the effect of interventions on frequent attenders have shown negative results. However, these trials were conducted in short-term frequent attenders.

Antibiotics and steroids for exacerbations of COPD in primary care: compliance with Dutch guidelines.

Background: The Dutch College of General Practitioners' guidelines specify that antibiotics should only be used for severe cases of chronic obstructive pulmonary disease (COPD). However, GPs tend to administer antibiotics rather than a short course of steroid treatment regardless of severity.

Aim: The aim of this study was to determine how GPs use current guidelines in treating exacerbations of COPD, in particular whether short courses of oral steroids and antibiotics are prescribed in accordance with the Dutch guidelines for COPD.